Healthcare Provider Details

I. General information

NPI: 1508984071
Provider Name (Legal Business Name): RAJESH N KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 LOUISIANA BLVD SE UNIT A
ALBUQUERQUE NM
87108-5001
US

IV. Provider business mailing address

925 LOUISIANA BLVD SE UNIT A
ALBUQUERQUE NM
87108-5001
US

V. Phone/Fax

Practice location:
  • Phone: 505-514-1441
  • Fax: 505-246-0235
Mailing address:
  • Phone: 505-514-1441
  • Fax: 505-246-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78-203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: